The New Plan

I spoke with Dr K earlier tonight regarding my injection and funky reaction. Of course he has never seen this happen before, the only possible thing he can attribute this to is some high signal in the capsule on the MRI. Given no other signs, and given the reaction to the injection, he does not think that Synvisc is the way to go at this time. He would rather I try a Platelet Rich Plasma (PRP) injection into the capsule and then see him 4 weeks later.

I am ok with this. Actually, I am so desperate to be pain free I would have agreed to pretty much anything at this point! Now the question is how long until his office can make this happen!!!

What A Waste

I am back to status quo, meaning, the way things were immediately before the injection. What does this mean?? My awful medial and posterior pain are gone, thank goodness. But the painfree days I had immediately post-injection are gone too, I am back to having old fashioned groin pain :-(

Now I most certainly have no idea what is going on and I am getting pretty upset about it. If I had "tweaked" my hip and caused some localized inflammation, the cortisone would have taken care of it. The fact that I had those 2 perfect days clearly shows that the pain is from the hip joint, but now the question is why??

I have a call in Dr. K, he will hopefully get back to me within a reasonable amount of time, or before I do something drastic, like amputate!!!

Despite Everything, I Still Have Something To Smile About

Not So Much Happiness

In all of my worse case scenarios, this was not even a possibility....Let me begin by saying that my injection was Tuesday, Wed and Thurs were amazing, I felt like I was dancing on clouds with rays of sunshine jutting out and birds chirping in my ear. Then came Friday. I woke up with some pain, as the morning went on, I kept feeling this horrendous pain a little more medially than where I normally do. I got home around 1PM and suddenly I could barely put weight on my leg. Of course I called J in a panic, who asked if I was going to be ok because he had to run into a meeting! That subsided but I have been left with really bad medial hip pain and posterior hip pain. All I can say is WTF??????????? I have no idea what is going on, what could have possibly happened, and why I am in so much pain? And why does my ass hurt all of a sudden?

Cortisone = Happiness

Yes! I am once again in a happy place in hipville!! I feel sooooo much better! I don't want to jinx anything but this seems to have done the trick. My plan is to give BK a call on Monday and let him know I am doing well, and re-visit the issue of more injections. It seems silly bc I feel so good now, but lets be honest here, cortisone is much like a bandaid, who knows what the real deal is here! I am just nervous that the cortisone will wear off and basically leave me f--ked all over again! Who would have ever imagined that things would get so complicated!

Injection # 5...over

A huge sigh of relief! My injection into the joint was about 5 1/2 hours ago. I have to say that the radiologist who does all of my injections is truly first class. He is so gentle and thorough. 2 hours ago I was completely pain free, it was such a wonderful feeling. Now the marcaine is beginning to wear off, I hope I am not in for a hellish night.

The injection went very smoothly. First he moved my hip around into deep flexion, then flexion with IR, then flexion with ER. I had to rate each position using a pain scale. Pre-injection I rated 5, 10 and 0 respectively.

He then marked the areas he did not want to inject and the area he did want to, injected a local to numb the skin, again, so gently. Then the big needle. It wasn't bad at all. Yes, I felt it, but it was a piece of cake. He then injected some contrast material and took an xray to see where the contrast went. It all kind of pooled around the femoral neck. He pulled up my old films and explained that he didn't like what he saw because last time, the contrast material moved more medially and did not pool like that. He decided to reposition the needle. Ugh. But again, it was not bad at all, and this time, the contrast spread as it was supposed to.

He injected everything in, gave it time to settle, and retested my hip ROM. This time, my pain was 0, 0 and 0.

So now what??

Hopefully, the pain will just go away, and never come back, and this was just a blip on the radar of successful hip arthroscopies!!!

Soccer

I have been quietly dealing with this flare up of hip pain but it is getting to the point where I am starting to lose it (again). What I have noticed is that soccer is making me soooo much worse. We are not talking about running through long fields, blocking balls with your head, diving into the ground soccer. What it is is playing with L and Jk, who are 5 and 3 1/2 respectively, just lightly kicking around a ball and stopping it with my foot. That is it. This seemingly innocent game is causing a hellish scene in my joint. By hellish I mean that given the opportunity, I may cut off my leg.

Interestingly, I wouldn't even rate the pain as that intense, it is the quality of pain that is getting to me. It is searing, aching, deep deep in the joint. Sound familiar? A little too close for comfort if you ask me.

Day 8

It is scheduled! Phew! Not until July 21st, but i'll take it, it is not worth the aggravation of having to have them call and see what is available, and call me back, So July 21st it is.

As I was about to write this, I got a call from HSS MRI department, calling me to confirm my MRI this Sunday.....huh? I already had my MRI. They said that someone from Dr. Kelly's office called to make me an appointment for an MRI of my right knee. Huh??? I told her to call Dr. Kelly's office since there seems to be a lot of confusion there. Maybe it was for the Laura they were looking for when they called me. So, Laura, if you read my blog, you have an MRI scheduled this Sunday at 3:30 @ HSS! Good Luck!

Day 7

You guessed it, nothing scheduled yet, not even a call back yesterday from his office. I have never heard of such complete and utter bullshit.

6 Days Later

It has been 6 days since BK and I spoke about getting a cortisone injection. It is not yet scheduled, I know, you are completely blown away. I called his office on Monday to schedule, they did not yet have the prescription, but I was assured that as soon as they had it they would call me! I called again yesterday, they were about to get the prescription and call me back...good thing I didn't wait all day by the phone. Actually, I shouldn't say that, they did call, except not for me. I got a call from his office asking for Laura, so I explained that I was not Laura but was indeed waiting for a call back from them, so again, I was assured that they would call me back "very soon". And here I am, waiting and waiting!!!

At least I am not waiting in a state of panic and anxiety, like I have been in the past, when the injection was the deciding factor between surgery and no surgery. This time, it won't change much other than (hopefully :-) my pain level!

I have added a "Follower" button to my blog, I am not 100% certain what it is, but a fellow hip blogger (Sarah) just sent me a link to hers and I see other blogger friends using it, so I figured it is the "thing" to do!!!

So What To Do Now????

So I spoke with Dr. K tonight regarding the MRI and the results. The good news is that there is no sign of an acute injury (subluxation, etc). There is some fluid in the psoas, and scarring on the capsule, both of which may be causing me trouble. He has never seen someone who presents the way I do (of course not, I am very special, he agreed) So...he thinks I should get an ultrasound guided psoas injection.

My last psoas injection was miserable, it took about 45 minutes, and following it, I lost all active hip flexion for a few days. I don't want to do that. He understands and is ok with that. He thinks I should then go ahead and get the joint injected, since the psoas and capsule will benefit from it as well. I don't know if this seems like a final solution, I just am not sure and I don't know what to do. I asked about getting Synvisc injected into the joint, he said he generally doesn't inject Synvisc into people "like me", meaning with no arthritis. I pointed out the cartilage thinning in the joint, he didn't think it was all that impressive. He said that if I go with Synvisc, they first do a cortisone injection about a week before, then 3-5 Synvisc injections after. Or, I could go with super duper non-FDA approved Synvisc that is given only one time. Or...I could go with a platelet rich plasma injection, of which the results are not yet conclusive.

So...... a lot of options, not a lot of evidence...nothing of great significance (shocker) on the MRI. So, I have decided to go ahead with a cortisone injection into the joint, I can then decide if I want to stop with that or continue on with the synvisc. I hope that this will be the solution for me because I am getting pretty fed up with hip pain!

My MRI Report Ordeal

As some of you know, I can be quite obsessive compulsive when it comes to test results. Mri #4 being no different! I was told that it would take 2 business days for the report to be done and delivered to Dr. K. My MRI was Fri at 7am. I called Tuesday, no report. I called again on Tues, no report. I called Wed, no report. So I called the radiology department directly (did I mention I have a touch of OCD), they confirmed that the report was indeed done, and had been sent to my doctor. Hmmmm, sigh! So I called his office yet again (they must love me) and informed them that the report was ready. I was told that they would send someone to go pick it up. I left my fax number and everything. No report. Today I was running out of patience, so I called his office again, no report. I told them it was done, and asked why they didn't have it, they told me that if they didn't have it by mon or tues (today is thurs) that they would send someone to go get it. I got off the phone feeling annoyed and exacerbated, called radiology again and explained my dilema. They offered to fax it to him (they can't fax it to me directly) on the spot, given my annoyance! 30 minutes later I called his office and they had it in the fax machine, now I hold a copy in my hot little hands!!!

Right Hip MRI #4 (edited)
There is mild trochnateric bursal thickening bilaterally. The anterior labrum is somewhat small probably related to debridement. the anterosuperior labrum is deficient, similar to the prior study, with the posterior labrum being intact. There is defect in the anterior capsule superiorly in the region of the surgery extending 2.5cm in transverse dimension.

Cartilage over the femoral head is thinned anterosuperiorly. Focally, there is no full thickness loss. the superior cartilage is high signal. The acetabular cartilage has thinning anterolaterally, slightly more prominent on the prior study as well as anterosuperiorly where there is a focal area of near full thickness loss which has increased from the prior study over 4mm. there is no prominent effusion. No reactive signal in the underlying bone is evident.

The patient has undergone anterior bumpectomy with remodeling of the anterior femoral neck. focal adjacent scar is evident.

There is iliopsoas tendon thickening and high signal representing tendinosis bilaterally.

Prior abdominal surgery has been performed

There is a transitional lumbosacral junction. Disc signal is mildly lost at what appears to be L4-5 where there is a small to moderate central disc protrusion. The sacroiliac joints show mild high signal and osteophytes. Minimal free fluid is the cul de sac. Hamstring origins are intact.
The muscles appear fairly symmetric.

The previously demonstrated left sided edema, presumably from arthroscopy of the left hip has dissipated.
There are 14 degrees of femoral anteversion.

Impression:
Interval bumpectomy since the prior study with postoperative scar and anterosuperior capsular defect.
There is persistently deficient anterosuperior labrum. Since the prior study, there has been a slight increase in the focal acetabular cartilage anterosuperiorly, without advanced arthrosis.